Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study

Stretti, Federica; Gotti, Miriam; Pifferi, S.; Brandi, Giovanna; Annoni, F; Stocchetti, Nino

doi:10.1186/s13054-014-0552-7

Cited by 21 publications

(21 citation statements)

References 27 publications

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“…Several series of clinical cases [60–62] showed a correlation between core temperature, brain temperature, and ICP. However, there is no randomized controlled study showing that TTM at 35–37 °C in patients with severe TBI was associated with prevention of intracranial hypertension.…”

Section: Resultsmentioning

confidence: 99%

Targeted temperature management in the ICU: guidelines from a French expert panel

Cariou

Payen

Asehnoune

et al. 2017

Ann. Intensive Care

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Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.

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Section: Resultsmentioning

confidence: 99%

Targeted temperature management in the ICU: guidelines from a French expert panel

Cariou

Payen

Asehnoune

et al. 2017

Ann. Intensive Care

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“…olan hastaların beden sıcaklığının izlendiği bir çalışmada, hastaların yalnızca %24'ünün hedeflenen beden sıcaklığında olduğu ve ateş kontrolünde yaygın olarak parasetamol kullanıldığı saptanmıştır (56%) (9). Ateş kontrolü amacıyla asetominofen ya da diklofenak uygulanan hastalarda, beden sıcaklığının 39.1 0 C'den 37.9 0 C'ye, KİB'ın 16 mmHg'dan 12 mmHg'ya düştüğü bulunmuştur (19). Cerrahi YBÜ'inde yapılan bir çalışmada, ateş kontrolünde en sık uygulanan ilaçların metamizol sodyum ve asetaminofen olduğu belirlenmiş-tir (25).…”

Section: Grafikunclassified

“…Ayrıca ateş, metabolizmayı hızlandı-rarak, glutamat salınımını, serbest radikallerin üretimini ve kan-beyin bariyerinin geçirgenliğini artırarak, serebral öde-me neden olur ve beyin üzerinde olumsuz etkiler oluşturur (12,19). Beden sıcaklığındaki her 1 0 C'lik artış, serebral kan akımını %5-6, metabolik gereksinimi %10 (20), KİB'ı ise 3-4 mmHg artırarak(8) nöroşirürji hastalarında ikincil yaralanmaların oluşumuna neden olmaktadır (11)(12)(13).…”

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“…Nöroşirurji hastaları-nın ateş kontrolünde hemşireler, hekim istemi doğrultu-sunda oral ya da intravenöz yolla farmakolojik tedaviyi (asetominofen, parasetamol, diklofenak vb.) uygulamakta (9,19,24) ve farmakolojik tedavi ile birlikte ya da tek başına fiziksel soğutma yöntemleri gibi farmakolojik olmayan yöntemleri kullanmaktadır (5,9,12,15,(24)(25)(26)(27). Bu araştırmada da nöröşirürji hastalarında istenmeyen sonuçlara neden olabilecek ateşin kontrolünde, yoğun bakım hemşirelerinin uyguladıkları hemşirelik girişimle-rini belirlemek amaçlandı.…”

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Nöroşirurji Yoğun Bakım Ünitesinde Ateş Kontrolünde Uygulanan Hemşirelik Girişimleri

Uğraş¹,

Yüksel²,

Yılmaz³

et al. 2020

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ÖZETGiriş-Amaç: Bedenin önemli savunma mekanizmalarından biri olan ateş, nöroşirürji hastalarında metabolik aktiviteyi hızlandıra-rak, kafa içi basınç (KİB) artışına neden olmakta ve iyileşme sürecini olumsuz etkilemektedir. Literatürde, nöroşirürji hastalarında ateş kontrolünün, ateşe bağlı gelişebilecek sorunların önlenmesinde etkili olduğu bildirilmektedir. Gereç-Yöntem NURSING INTERVENTIONS TO CONTROL FEVER IN A NEUROSURGICAL INTENSIVE CARE UNIT ABSTRACTIntroduction: Whilst fever is one of the key defence mechanisms of the body, it also causes raised intracranial pressure (ICP) by accelerating metabolic activity in neurosurgical patients and adversely affects the healing process. In the literature, fever control in neurosurgical patients is reported to be effective in preventing adverse consequences arising from uncontrolled fever.Material and Methods: This study employs a retrospective descriptive methodology. It was undertaken by examining a sample of medical records for 72 patients. All were over 18 years of age, had remained in the Neurosurgical Intensive Care Unit of a University Hospital for at least one week and had a recorded axillary temperature exceeding 38°C. Written permission from the Ethics Committee of the relevant institution was obtained to allow the research to proceed. Data were gathered between September 2013 and February 2014 using a data collection form developed by the researchers. Descriptive statistical methods (frequency, average, standard deviation) were used for the data analysis.Results: 72 out of 180 (40%) patients admitted to NICU between 2010 and 2014 developed a fever. The principal interventions by nurses to maintain fever control were identified as: giving an antipyretic agent by doctor's order (98.6%), using a cooling electrical fan (88.9%), giving a tepid bed bath (75%) and adjusting the room temperature or removing blankets (72.2%). The most frequently used antipyretic agents were identified as metamizole sodium (27.8%), a combination of metamizole sodium and paracetamol (26.4%) or paracetamol alone (16.7%). Conclusion:From the study data, it was determined that the most frequent method used to provide fever control in NICU patients was pharmacological, and that the most frequently used nursing interventions were attempts at physical cooling.

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“…The fact that the relationship between the PI and ICP was unclear blurred the utility of the PI for evaluation of cerebral hemodynamics . As many factors affect the PI, it should be interpreted with caution rather than ignored . In our clinical practice, we have found that an abnormal PI of the middle cerebral artery (MCA) indicates an imbalance between systemic and cerebral hemodynamics.…”

mentioning

confidence: 99%

Use of a Doppler‐Based Pulsatility Index to Evaluate Cerebral Hemodynamics in Neurocritical Patients After Hemicraniectomy

Gao

et al. 2019

J of Ultrasound Medicine

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ObjectivesAs a noninvasive method for evaluation of cerebral hemodynamics, the correct interpretation of transcranial Doppler or transcranial imaging (TCI) data remains a major challenge. We explored how to interpret the pulsatility index (PI) derived via TCI during evaluations of cerebral hemodynamics in posthemicraniectomy patients.MethodsWe included patients who underwent invasive arterial pressure and intracranial pressure (ICP) monitoring and simultaneous TCI examinations after hemicraniectomy. We classified the PI of the middle cerebral artery (MCA) into ipsilateral (craniectomy side) and contralateral (opposite side) and analyzed both data sets. The statistical analysis was performed by the Bland‐Altman approach, by calculating intraclass correlation coefficients and Spearman correlations, and by drawing receiver operating characteristic curves. Pulsatility index probability charts were created for ICPs exceeding 20, 25, and 30 mm Hg and cerebral perfusion pressures (CPPs) lower than 70, 60, and 50 mm Hg; we thus explored defined ICP and CPP values.ResultsThe ipsilateral and contralateral MCA PI data differed. Only the ipsilateral MCA PI showed a weak correlation with ICP (r = 0.378; P < .001). The receiver operating characteristic curve analysis revealed limited diagnostic utility of bilateral MCA PIs for ICP and CPP assessments. An extremely elevated MCA PI indicated that patients were at high risk of a dangerous ICP elevation or CPP reduction. However, MCA PI values within the normal range did not effectively rule out an ICP of 20 mm Hg or higher but effectively eliminated a CPP lower than 50 mm Hg.ConclusionsIn posthemicraniectomy patients, the Doppler‐based MCA PI value was ineffectively for quantitative ICP and CPP evaluations but a useful index for assessment of cerebral hemodynamics in terms of the probability of an ICP elevation or a CPP reduction.

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Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study

Cited by 21 publications

References 27 publications

Targeted temperature management in the ICU: guidelines from a French expert panel

Targeted temperature management in the ICU: guidelines from a French expert panel

Nöroşirurji Yoğun Bakım Ünitesinde Ateş Kontrolünde Uygulanan Hemşirelik Girişimleri

Use of a Doppler‐Based Pulsatility Index to Evaluate Cerebral Hemodynamics in Neurocritical Patients After Hemicraniectomy

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